The surgeon general is calling attention to widespread mental health challenges among youths and laid out expansive actions to protect them.
These issues have been exacerbated by the COVID-19 pandemic and will take a whole-of-society effort to address, Surgeon General Vivek H. Murthy, M.D., M.B.A., said in a new advisory that includes recommendations for health care providers.
“I believe that, coming out of the COVID-19 pandemic, we have an unprecedented opportunity as a country to rebuild in a way that refocuses our identity and common values, puts people first, and strengthens our connections to each other,” Dr. Murthy said in the advisory. “If we seize this moment, step up for our children and their families in their moment of need, and lead with inclusion, kindness, and respect, we can lay the foundation for a healthier, more resilient, and more fulfilled nation.”
The advisory comes on the heels of the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declaring a national emergency in children’s mental health.
Mental, emotional, developmental or behavioral disorders have been reported in about 20% of children ages 3-17 years, and many are not receiving adequate treatment, according to the surgeon general’s advisory.
Children’s mental health can be impacted by biological and environmental factors, including genetics, relationships with family and friends, community support and societal challenges. Adverse childhood experiences can cause toxic stress, which can lead to long-lasting physical and mental health issues.
Inequities also persist. Black children under 13 years are nearly twice as likely to die by suicide as White children, and youths with socioeconomic disadvantages are two to three times more likely to develop mental health conditions than their peers, according to the advisory.
In recent years, mental health challenges have been increasing. Roughly one-third of high school students reported persistent feelings of sadness or hopelessness in 2019, up 40% from a decade prior, according to the advisory. Likewise, the rate of those seriously considering a suicide attempt and those creating a suicide plan increased 36% and 44%, respectively.
Dr. Murthy noted increases could be due in part to more willingness to discuss mental health, but he also cited growing use of digital media, drug and alcohol use, limited access to care and societal challenges like income inequality, racism, gun violence and climate change.
The pandemic has exacerbated these challenges by increasing fear, grief, isolation and economic hardships. Some children spent months out of school, and their access to health care and social services has been even more limited.
Dr. Murthy said everyone can take steps to address youth mental health and laid out recommendations that range from individual to systemic.
His broad recommendations include:
- Recognize that mental health is an essential part of overall health.
- Empower youths and their families to recognize, manage and learn from difficult emotions.
- Ensure every child has access to high-quality, affordable and culturally competent mental health care.
- Support the mental health of children in a variety of settings.
- Address economic and social barriers.
- Increase timely data collection and research.
Actions for health care professionals include:
- Implement trauma-informed care principles and other prevention strategies.
- Routinely screen children for mental health challenges and risk factors.
- Identify and address mental health needs of family members.
- Combine efforts with trusted community partners and child-serving systems.
- Build multidisciplinary teams to implement tailored services.
Dr. Murthy also proposed actions for young people, family members, educators, media companies, social media/gaming companies, community organizations, philanthropic organizations, employers and governments.
“If we each start reorienting our priorities to create accessible space in our homes, schools, workplaces, and communities for seeking and giving assistance, we can all start building a culture that normalizes and promotes mental health care,” Dr. Murthy wrote. “This is the moment to demand change — with our voices and with our actions.”
- Surgeon general advisory "Protecting Youth Mental Health"
- AAP mental health initiatives
- Information from physician organizations, including the AAP, on integrating behavioral health care into a clinical practice
- AAP interim guidance on children’s emotional and behavioral health during the pandemic
- Information for parents from HealthyChildren.org on mental health during the pandemic
- Information for parents from HealthyChildren.org on childhood grief